Autism Speaks spells out changes in TRICARE. An excerpt:
Referral and authorization of services are required for all ABA care. We have outlined the following steps to help walk you through this complicated process:
1. Parents must get a referral for ABA from their Physician Primary Care Manager (P-PCM) or from a specialized autism provider.
2. The Managed Care Support Contractor (MCSC) will then refer beneficiaries for an “ABA assessment” to be conducted by an ABA provider.
3. The ABA assessment must include psychometric testing using the Autism Diagnostic Observations Scale, second edition (ADOS-2), and the Vineland Behavioral Scale II (VBS-II).
4. Based on the results of the ABA assessment, the referring provider must submit a referral to the MCSC for an authorization of ABA. Please note there are significant changes to the minimum information that the referring physician or psychologist must include as part of your referral. All authorizations are good for one year.
What if my ABA provider is not qualified to administer the ADOS-2 or VBS-II?
If the ABA provider conducting the ABA assessment is not qualified to administer the ADOS-2 or the VBS-II tests, your referring provider must provide you with an additional referral to qualified TRICARE provider that can administer the tests (such as a developmental pediatrician, licensed clinical psychologist, etc.).
What happens if there are wait lists for these providers or I am unable to find a provider in my area to deliver this testing?
The TRICARE policy is silent on this issue. Autism Speaks is aware there is a shortage of specialty care providers in many of our military communities, especially in rural areas. We are very concerned that the absence of available provides will impede access to care for children.
How often are these psychometric tests required?
The VBS-II must be administered every 180 days and the ADOS-2 is required annually.
Why are all of these testing requirements necessary?
TRICARE is now requiring psychometric testing to verify progress on a beneficiary’s treatment plan. Autism Speaks is very concerned about the new testing requirements and that TRICARE is using the results of the psychometric testing for purposes they were not validated for.
So, my child has to show progress on the psychometric tests to continue ABA services?
Yes. We understand that this represents a significant shift in how TRICARE covers all other medical services and fails to address the challenges and needs individuals with autism often experience.